Device and methods for lifting patient tissue during laparoscopic surgery

ABSTRACT

A method of manipulating patient tissue with a surgical device that provides a suction force against a patient&#39;s body. The device includes a handle and a suction head pivotally attached to the handle. The suction head includes an open-ended suction chamber having a rim positioned to engage the patient&#39;s skin. An actuator on the handle operates a pump to draw a negative pressure in the suction chamber, causing the rim to seal against the patient&#39;s skin via the suction force. Once the suction force is initiated, the user may lift the handle away from the patient&#39;s body to lift tissue. The lifted tissue provides a site for insertion of a trocar or Veress needle for a laparoscopic procedure in some embodiments. A gimbal disposed between the handle and the suction head provides at least two degrees of freedom such that the handle can be rotated and pivoted to optimize the direction of applied lifting force.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application claims priority to and benefit of co-pending U.S.patent application Ser. No. 15/800,412 entitled “Device and Methods forLifting Patient Tissue During Laparoscopic Surgery”, which is acontinuation of U.S. patent application Ser. No. 15/601,941 entitled“Device and Methods for Lifting Patient Tissue During LaparoscopicSurgery,” which claims priority to Provisional Patent Application No.62/339,424 entitled “Surgical Device,” all of which are herebyincorporated by reference in their entireties.

A portion of the disclosure of this patent document contains materialthat is subject to copyright protection. The copyright owner has noobjection to the reproduction of the patent document or the patentdisclosure, as it appears in the U.S. Patent and Trademark Office patentfile or records, but otherwise reserves all copyright rights whatsoever.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not Applicable.

REFERENCE TO SEQUENCE LISTING OR COMPUTER PROGRAM LISTING APPENDIX

Not Applicable.

BACKGROUND

The present disclosure relates generally to surgical devices and moreparticularly to a device and methods for lifting tissue of a patientprior to insertion of a surgical instrument such as a trocar or Veressneedle.

During various surgical procedures, including laparoscopy, surgicalinstruments such as a trocar, Veress needle or access port may beinserted into the tissue of a human or animal. In some procedures, theinstrument is inserted in a position to access the abdominal cavity. Theinitial surgical instrument or trocar is preferably placed through theumbilicus because the abdominal wall is at its thinnest in this region.A laparoscopic camera is then placed through this initial trocar to aidin visualizing the intraabdominal cavity and the structures therein.Carbon dioxide gas is then used to insufflate the abdominal cavity,thereby creating a pneumoperitoneum or space to operate. Once thepneumoperitoneum is created, secondary trocars can be placed underdirect visualization utilizing the laparoscopic camera thus reducing therisk of injury.

Patient injuries most often occur during initial placement of the trocaror Veress needle, which is generally considered to be the most dangerousportion of a laparoscopic surgery. Currently, there are two commonmethods for the placement of the primary umbilical trocar: the blindtechnique and the open (Hasson) technique.

The blind technique can be accomplished either before or after thecreation of the pneumoperitoneum. Some surgeons prefer insufflating theabdominal cavity prior to the placement of the initial trocar. This isaccomplished with the use of a Veress needle. The needle is blindlyintroduced through an umbilical incision. Carbon dioxide gas isintroduced through the Veress needle, elevating the abdominal wall awayfrom the underlying structures. The Veress needle is then removed, andthe primary trocar placed.

Other surgeons prefer placing the primary trocar prior to insufflatingthe abdomen. This is the direct entry method and is performed using atechnique called a “controlled jab.” The trocar is placed through anumbilical incision under controlled force using a stabbing motion withcare not to penetrate beyond the abdominal wall. Most surgeons elevatethe abdominal wall during blind insertion of either the primary trocaror the Veress needle. This reduces the risk of injury to underlyingstructures.

The most common type of injury is to vascular structures, bowel, or toother visceral organs. Multiple studies have shown that complicationrates are similar between the Veress needle and direct entry as well asbetween the blind technique and the open Hasson technique. Varioustechniques and inventions have been described to assist with elevationof the abdominal wall to facilitate blind trocar or Veress needleplacement. This includes rarely used devices such as retractors andlifting rods used to mechanically elevate the abdominal wall therebycreating negative pressure within the abdomen allowing a space forinitial trocar placement or room to operate without the need forcreating a pneumoperitoneum.

More commonly, two conventional manual techniques for lifting theabdominal wall are utilized. The first method involves grasping andlifting the abdominal wall below or on either side of the umbilicus withone's hand. The second method utilizes perforating towel clips placed ina similar location to provide a handle on which to lift and elevate theabdominal wall. Each of these techniques require that sufficientelevation of the abdominal wall is maintained in opposition to thedownward force generated during primary trocar or Veress needleplacement. Although providing a more secure grasp of the abdominal wall,towel clips pierce the abdominal skin and therefore risk injury andtrauma to vessels and tissue. This is also a source of postoperativediscomfort to what is intended to be a minimally invasive procedure.Grasping and lifting the abdominal wall by hand poses its ownchallenges. Whether the surgeon is lifting the abdomen below theumbilicus or the surgeon and his assistant are lifting on either side ofthe umbilicus, it can be difficult to maintain a grip and the properelevation to insure inadvertent injury does not occur to the underlyingstructures. The shape, elasticity and overall thickness of the abdominalwall can also prohibit one from adequately grasping the abdomen by hand.Also, lifting the full thickness of the abdominal wall by hand risksinadvertently grasping and elevating the omentum and other underlyingstructures together with the abdominal wall bringing these structuresinto the path of the trocar or Veress needle.

In an effort to improve on current tools and techniques, a number ofdevices have been developed. One recent apparatus, marketed under thename of LapDome by Narbitas, utilizes a dome shaped device and negativepressure generated from external operating room suction to raise theabdominal wall within the dome thereby creating intraabdominal space. AVeress needle is then introduced through the dome and into the elevatedabdominal cavity. The abdominal cavity is then insufflated with carbondioxide gas, and the surgery can commence as usual.

There are several drawbacks to using the LapDome and similar devices.First, it is a bulky apparatus fixated over the abdomen and umbilicusand requires external suction to create lift within the device. Second,the LapDome can be used only with the Veress needle technique andtherefore limits a surgeon to a technique that he or she may not becomfortable with performing.

What is needed then are improvements to devices and methods forlaparoscopic surgery, and particularly for manipulating and liftingpatient tissue for insertion and placement of a surgical device during asurgical procedure, such as but not limited to a trocar or Veressneedle.

BRIEF SUMMARY

This Brief Summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription. This Summary is not intended to identify key features oressential features of the claimed subject matter, nor is it intended tobe used as an aid in determining the scope of the claimed subjectmatter.

One aspect of some embodiments of the present disclosure is a surgicaldevice including a handle and a suction head attached to the handle at apivotable joint. The joint allows relative angular motion between thesuction head and the handle in at least one angular degree of freedom. Amanual pump is disposed on the handle, and an actuator is coupled to thepump. A user may manipulate the actuator to operate the pump, therebycreating a suction force between the suction head and the skin of apatient. Once a suction force is established between the suction headand the patient, the user may then lift the surgical device away fromthe patient's body to lift tissue for trocar insertion.

Another aspect of some embodiments of the present disclosure provides asurgical device including a handle and a suction head attached to thehandle at an articulating joint. A gimbal device is positioned at thejoint between the suction head and the handle in some embodiments. Thegimbal provides a first angular degree of freedom between the gimbal andthe handle, and a second angular degree of freedom between the gimbaland the suction head. Thus, the gimbal operates as an intermediatestructure between the handle and the suction head to allow relativeangular movement between the handle and the suction head in at least twodegrees of freedom.

A further aspect of some embodiments of the present disclosure providesa surgical device including a handle and a suction head, wherein anegative pressure suction force may be easily released by manualoperation of a pressure release on the suction head.

Another object of some embodiments of the present disclosure is toprovide a device and associated methods to lift tissue prior to trocaror Veress needle insertion to allow surgeons to utilize either trocarinsertion method.

Another object of some embodiments of the present disclosure is toprovide a surgical device for lifting a patient's tissue for insertionof a surgical instrument such as a trocar, wherein the device allows theuser to move an actuator in the same direction as the axial pull forcefor lifting the tissue.

Numerous other objects, advantages and features of the presentdisclosure will be readily apparent to those of skill in the art upon areview of the following drawings and description of a preferredembodiment.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an embodiment of a surgical device inaccordance with the present disclosure.

FIG. 2 is a perspective view of an embodiment of a surgical device inaccordance with the present disclosure.

FIG. 3 is a perspective view of an embodiment of a surgical device inaccordance with the present disclosure.

FIG. 4 is a perspective partial cross-sectional view of an embodiment ofa surgical device in accordance with the present disclosure.

FIG. 5 is a perspective view of an alternative embodiment of a surgicaldevice in accordance with the present disclosure.

FIG. 6 is a perspective view of an alternative embodiment of a surgicaldevice in accordance with the present disclosure.

FIG. 7 is a perspective view of an alternative embodiment of a surgicaldevice in accordance with the present disclosure.

FIG. 8 is a perspective view of an alternative embodiment of a surgicaldevice in accordance with the present disclosure.

FIG. 9 is a front elevation view of an alternative embodiment of asurgical device in accordance with the present disclosure.

FIG. 10 is a side elevation view of an alternative embodiment of asurgical device in accordance with the present disclosure.

FIG. 11 is an exploded perspective view of an alternative embodiment ofa surgical device in accordance with the present disclosure.

FIG. 12 is an exploded cross-sectional elevation view of an alternativeembodiment of a surgical device in accordance with the presentdisclosure.

DETAILED DESCRIPTION

While the making and using of various embodiments of the presentinvention are discussed in detail below, it should be appreciated thatthe present invention provides many applicable inventive concepts thatare embodied in a wide variety of specific contexts. The specificembodiments discussed herein are merely illustrative of specific ways tomake and use the invention and do not delimit the scope of theinvention. Those of ordinary skill in the art will recognize numerousequivalents to the specific apparatus and methods described herein. Suchequivalents are considered to be within the scope of this invention andare covered by the claims.

In the drawings, not all reference numbers are included in each drawing,for the sake of clarity. In addition, positional terms such as “upper,”“lower,” “side,” “top,” “bottom,” etc. refer to the apparatus when inthe orientation shown in the drawing, or as otherwise described. Aperson of skill in the art will recognize that the apparatus can assumedifferent orientations when in use.

Referring to FIG. 1, an embodiment of a surgical device 10 is shown in aperspective view. Device 10 includes a handle 12 and a suction head 14.Handle 12 is attached to suction head 14 at a moveable joint 16. Duringuse, a user may grasp handle 12 while suction head 14 engages apatient's body. Suction head 14 includes a suction cup 24 having an opensuction chamber 22. A rim 28 is positioned to engage a patient's body.An actuator 18 on handle 12 is coupled to a pump mechanism housed withinthe device. When rim 28 is positioned against a patient's body, actuator18 is manipulated to cause the pump mechanism to draw a negativepressure between the patient's body and the suction head 14. Rim 28operates as a seal between the patient's skin and the suction head 14.Once a negative pressure suction force is established between the device10 and the patient via the suction head 14, the user may then use handle12 to manually lift the patient's tissue while maintaining a negativepressure seal between the patient's body and the rim 28. Once the tissueis lifted, the user may then insert a trocar or Veress needle using anysuitable insertion technique.

After the surgical instrument is inserted, the negative pressure suctionforce is released by operation of a pressure release 32 on the device10. One or more pressure release ports 34, shown in FIG. 3, are definedin suction head 14 in some embodiments. Each pressure release port 34passes through the suction head 14 to allow gas transfer across suctionhead 14. When a negative pressure is pulled in suction chamber 22,pressure release 32 is held down against the exterior of suction head14, thereby blocking entry of gas into the suction chamber. In suchembodiments, the pressure release 32 is closed. An upturned edge aroundthe perimeter of pressure release 32 provides a location for a user tomanually lift the pressure release 32. When pressure release 32 islifted away from suction head 14, one or more pressure release ports 34are opened and the suction force created in suction chamber 22 isreleased as air enters suction chamber 22 quickly through the pressurerelease ports 34. The pressure release 32 provides a convenient way fora user to quickly release the suction of the device against a patientduring an operation.

Referring to FIG. 1 and FIG. 2, in some embodiments, device 10 includesa joint 16 between handle 12 and suction head 14. Joint 16 provides afirst angular degree of freedom about a reference horizontal axis 17.This first angular degree of freedom allows handle 12 to pivot towardand away from the patient's body when in use. The first angular degreeof freedom also allows a user to angle the handle relative to suctionhead 14 for applying a pulling force in various directions away from thepatient's body. Notably, the degree of freedom offered by joint 16 insome embodiments, and the at least two degrees of freedom offered byjoint 16 in additional embodiments, provide a user with the ability tolift the patient tissue at various angles of application of liftingforce. This further allows a user to properly position the user's handsout of the way of the trocar insertion or Veress needle insertion duringthe laparoscopic surgical procedure using device 10.

As further seen in FIG. 2, in additional embodiments, device 10 includesa joint 16 between handle 12 and suction head 14 that provides a secondangular degree of freedom about a reference vertical axis 19. The secondangular degree of freedom allows a user to pivot the handle relative tothe suction head 14 when the suction head 14 is engaged with thepatient's body. For example, during use, a user may press suction head14 against a patient's body. Then, the user may manipulate actuator 18along travel slot 54 to draw a negative pressure suction force betweensuction head 14 and the patient's body. Once the suction force isestablished, the user may then pivot handle 12 relative to suction head14 about vertical axis 19 via joint 16. In such embodiments, joint 16may be referred to as having two degrees of freedom—a first degree offreedom about reference axis 17, shown in FIG. 1, and a second degree offreedom about reference axis 19, shown in FIG. 2.

Alternatively, in some embodiments, joint 16 includes only the firstdegree of freedom about reference axis 17. In further embodiments, joint16 includes only the second degree of freedom about reference axis 19.

During use, a negative pressure suction force is established in suctionhead 14 using a pump mechanism. Negative pressure is established insuction head 14 using a suction port 48 in fluid communication with thepump mechanism. Suction port 48, shown in FIG. 3, provides one or moreorifices in suction head 14 that are open on one side to suction chamber22 and are open on the other side to the pump mechanism 90, shown inFIG. 4.

A suction valve 44 is disposed in suction head 14 to seal suctionchamber 22 with a negative applied pressure in some embodiments. Suctionvalve 44 includes any suitable valve for drawing and holding a reducedpressure in suction chamber 22 via suction port 48. For example, as seenin FIG. 4, an embodiment of a suction valve 44 in suction head 14includes an umbrella valve positioned above suction port 48. The valveoperates as a check valve, allowing negative pressure to be drawn fromsuction chamber 22 while preventing the flow of gas back into suctionchamber 22 when rim 28 is sealed against a patient's body.

Suction valve 44 is seated in a stem 40 on suction head 14 in someembodiments, as seen in FIG. 4. Stem 40 includes a protruding structureextending upwardly from the suction head 14 allowing attachment to joint16. Stem 40 includes a hollow interior stem channel 50, and a stem wall52 spanning the stem channel 50. Stem wall 52 forms a separation betweensuction chamber 22 and stem channel 50. One or more suction ports 48 aredefined in stem wall 52, and suction valve 44 is seated in stem channel50 on stem wall 52 in some embodiments. During use, when a negativepressure is drawn on suction head 14 via stem channel 50, suction valve44 opens slightly to allow the negative pressure to act on suctionchamber 22 via suction ports 48, thereby drawing a correspondingnegative pressure on suction chamber 22. When the desired negativepressure is reached, suction valve 44 presses back down against stemwall 52 thereby blocking suction ports 48 and maintaining the reducedpressure in suction chamber 22.

In some embodiments, a gimbal 60 provides joint 16 between handle 12 andsuction head 14. Gimbal 60 includes an intermediate structure locatedbetween handle 12 and suction head 14 to provide two angular degrees offreedom between handle 12 and suction head 14. Gimbal 60 includes afirst pivoting gimbal joint 62 between gimbal 60 and handle 12, shown inFIG. 2. First gimbal joint 62 allows handle 12 to pivot about areference horizontal axis 17, as seen in FIG. 1. First gimbal joint 62includes a first gimbal joint seal between gimbal 60 and handle 12. Thefirst gimbal joint seal may include any suitable seal for maintaining apressure-tight seal along first gimbal joint 62 during articulationbetween handle 12 and gimbal 60 when suction is pulled on handle 12using the pump mechanism. First gimbal joint seal includes an O-ring orgasket in some embodiments. First gimbal joint seal ensures that thatany applied negative pressure from the pump mechanism in handle 12 iscommunicated and maintained through the interior port in gimbal 60 tosuction head 14. Gimbal 60 may be secured to handle 12 using anysuitable connection for allowing relative rotation between handle 12 andgimbal 60 about reference horizontal axis 17, and while preventing axialmovement between handle 12 and gimbal 60 along reference horizontalaxis. In some embodiments, handle 12 is attached to gimbal 60 using oneor more mechanical fasteners such as bolts, set screws, clips or othersuitable fasteners.

A second gimbal joint 64, shown in FIG. 2, provides a second angulardegree of freedom, providing a pivoting joint between gimbal 60 andsuction head 14. A second gimbal joint seal is disposed in second gimbaljoint 64 to maintain a suction seal during rotation of gimbal 60 andhandle 12 relative to suction head 14 while suction head 14 is engagedwith a patient's skin. Thus, second gimbal joint 64 allows handle 12 tobe rotated relative to suction head 14 about a reference vertical axis19. Second gimbal joint seal may include any suitable seal such as butnot limited to an O-ring or a gasket. Second gimbal joint seal maintainsa sealing engagement between gimbal 60 and suction head 14 duringrotation of handle 12 relative to suction head 14 and during applicationof suction force to the patient's tissue using suction head 14. Suctionhead 14 may be secured to gimbal 60 at second gimbal joint 64 in anumber of different ways to provide relative sealed rotation between thestructures about reference vertical axis 19. For example, in someembodiments, a horizontal U-shaped retaining pin may be installed ingimbal 60 to engage a corresponding stem groove in stem 40 on suctionhead 14. When the retaining pin is installed in the stem groove, thesuction head 14 is secured in axial position relative to gimbal 60,thereby allowing gimbal 60 to rotate about reference vertical axis 19relative to suction head 14, but preventing axial movement betweensuction head 14 and gimbal 60.

A vacuum gauge, or suction gauge 70, shown in FIG. 1, is disposed ongimbal 60 in some embodiments. Vacuum gauge 70 extends from gimbal alongreference horizontal axis 17 in some embodiments. Vacuum gauge 70 ismaintained in position along a gimbal port 66, shown in FIG. 4. Gimbalport 66 provides a passage through the gimbal for communicating pressurefrom pump 90 to suction head 14. Vacuum gauge 70 is disposed in anopening in communication with gimbal port 66, and a gauge spring 74provides a spring force to maintain vacuum gauge 70 at an equilibriumposition. When a reduced pressure is applied on suction head 14 throughgimbal port 66, the pressure reduction causes vacuum gauge 70 totranslate against gauge spring 74, retracting partially into the gimbal60. One or more indicia 72 on vacuum gauge 70 provides information abouta desired applied pressure level. For example, in some embodiments,indicia 72 includes a color band or a line indicating an acceptableapplied pressure range for achieving a desired suction force on suctionhead 14. The pressure range corresponding to the indicia is apredetermined pressure range in some embodiments that has beencalibrated to be a sufficient pressure to achieve a desirable suctionforce for lifting patient tissue using the device 10. When acorresponding pressure drop across gimbal port 66 is achieved, vacuumgauge 70 will retract such that the indicia 72 of a color band or lineis aligned with vacuum gauge keeper 76, shown in FIG. 3. Alternatively,indicia 72 may be measured against another point of reference includingany suitable structure on gimbal 60. The vacuum gauge 70 allows a userto visually determine when a desired negative pressure is achieved insuction head 14. Once the desired suction pressure is confirmed byvisual observation of vacuum gauge 70, the user may then pull on handle12 to lift the patient's tissue for insertion of a surgical instrumentsuch as a trocar or Veress needle.

Referring further to FIG. 4, a pump 90 is disposed in handle 12 in someembodiments. Pump 90 includes a pump piston 80 that is moveable alongthe interior of handle 12. Handle 12 forms a pump piston cylinder 84 insome embodiments. During use, pump piston 80 translates along the pumppiston cylinder 84 on the interior of handle 12. A pump piston seal 86is positioned between pump piston 80 and pump piston cylinder 84. Pumppiston seal 86 is a slidable seal such as an o-ring in some embodiments.Actuator 18 is linked to pump piston 80 such that translation ofactuator 18 along travel slot 54 results in a corresponding motion ofpump piston 80 along pump piston cylinder 84. Pump spring 82 pressesagainst pump piston 80 and biases pump piston 80 in a position at thelower end of handle 12 toward suction head 14.

A spring stop 92 is installed on pump 90 inside handle 12. Spring stop92 provides an axial stop for pump spring 82, which is a compressionspring in some embodiments. Spring stop 92 also forms an end wall forpump piston cylinder 84. Spring stop 92 may be threaded into handle,secured in place using one or more fasteners, or fixed relative tohandle 12 using any suitable fastening means such as but not includingan adhesive or integrally molded into handle 12. Spring stop 92 alsoincludes a spring pilot rod 94 extending axially downwardly towardsuction head 14 in some embodiments. Spring pilot rod 94 includes aprojecting rod positioned on the interior of pump spring 82, as shown inFIG. 4. Spring pilot rod 94 in some embodiments prevents pump spring 82from buckling or becoming misaligned during spring compression thatoccurs during a stroke of pump 90.

During a procedure, a surgeon or assistant may grasp handle 12 and use afinger or thumb to move actuator 18 away from suction head 14, therebycausing pump piston 80 to translate away from suction head 14 along pumppiston cylinder 84 inside handle 12. Such motion of pump piston 80 awayfrom suction head 14 draws a negative pressure inside the pump pistoncylinder 84. The negative pressure is maintained by pump piston seal 86.A corresponding negative pressure is also drawn through gimbal port 66,and through suction port 48 in suction head 14, causing a pressure dropin suction chamber 22. The negative pressure created by movement ofactuator 18 creates a suction force on a patient's skin in suctionchamber 22, thereby allowing a user to lift the patient's tissue forinsertion of a surgical instrument such as a trocar or Veress needle.

In some applications, it may be necessary to initiate multiple pumpstrokes to achieve a desired suction pressure. For example, whenactuator 18 is pulled to the end of its travel range, the pump spring 82is operable to force the actuator and piston back toward the suctionhead 14. A pump valve 88 is included on pump piston 80 in someembodiments. Pump valve 88 is a check valve in some embodiments that isclosed when pump piston 80 is drawn away from suction head 14, but isopened when pump piston 80 returns back toward suction head 14 to itsstarting position. The pump valve 88 allows the gas in pump pistoncylinder 84 to vent out of the cylinder as the pump piston 80 returnsvia the pump spring 82.

In various alternative embodiments, different configurations of joint 16and actuator 18 may be provided. Such alternative embodiments include ahandle 12 and a suction head 14 configured for applying a suction forceagainst a patient's skin. An example of an alternative embodiment of asurgical device 10 is shown in FIG. 5. The device 10 shown in FIG. 5includes a center gimbal allowing for rotation about a referencehorizontal reference axis 17 only. In this embodiment, the joint 16includes only one angular degree of freedom. A spring stop 92 includesan adjustable end cap that may be axially adjusted relative to handle 12by rotating the end cap in some embodiments. This allows a user tomodify the axial grip length of the handle 12 for ergonomic purposes byadjusting the distance between the axial end cap and the actuator 18.The spring stop 92 including an adjustable end cap may also include anergonomic shape such as an oval or hemisphere to comfortably fit in thepalm of the user's hand. In some embodiments, the adjustable end cap isseparate from the spring stop 92 housed within handle 12. In otherembodiments, the adjustable end cap is integrally formed with the springstop 92 as a single piece. Also shown in FIG. 5, an alternativeembodiment of actuator 18 includes a single piece with opposing fingergrips. The actuator 18 is inserted completely through handle 12 suchthat each opposing finger grip extends from an opposing side of handle12. In other embodiments, each finger grip is a separate individualpiece, as shown in FIG. 4.

Referring to FIG. 6, an alternative embodiment of a surgical device 10is shown with a side gimbal design. In this embodiment, actuator 18includes a continuous finger holder extending in a ring around handle12. As shown in FIG. 6, this embodiment may also include a spring stop92 forming an adjustable end cap that may be axially adjusted relativeto handle 12 by rotating the end cap. Also shown in FIG. 5, pressurerelease 32 may take numerous forms to allow a release of negativepressure held inside suction chamber 22. In some alternativeembodiments, as shown in FIG. 6, pressure release 32 includes a knobthat may be released by turning, pressing or bending to open a seal onpressure release 32 to quickly release the suction drawn in suctionchamber 22 against a patient's tissue.

Referring to FIG. 7, an alternative embodiment of a surgical device 10includes a joint 16 having a bevel configuration. This configurationallows the handle 12 to be rotated relative to suction head 14 byturning about the beveled joint to achieve a desired orientation ofhandle relative to suction head 14.

Referring to FIG. 8, an alternative embodiment of a surgical device 10includes an actuator 18 having a pivotable lever on handle 12. When auser depresses the lever on actuator 18, the pump housed within handle12 is stroked. Another feature shown in FIG. 8 is the use of a flexiblemedical tubing for the joint 16 between handle 12 and suction head 14.Flexible medical tubing may take the place of gimbal 60 in forming joint16. The tubing allows at least two angular degrees of freedom betweenhandle 12 and suction head 14, allowing handle to be pivoted relative tosuction head 14 about reference horizontal axis 17 and also pivotedabout reference vertical axis 19.

Referring to FIGS. 9-12, an alternative embodiment of a surgical device10 is shown in a front view. The device 10 includes a handle 12 and asuction head 14. Handle 12 is secured to suction head 14 at anarticulating joint 16. In some embodiments, joint 16 includes a ball andsocket joint, including a ball on suction head 14 and a socket attachedto handle 12. As shown in the alternative embodiment, a suction forcemay be applied in suction head 14 by using an axial stroking action ofactuator 18 on handle 12. During use, an operator may grasp the actuatorportion 18 on handle 12. Actuator 18 is moved up and down relative tohandle 12 to actuate a pump housed on the interior of handle 12 andactuator 18. The upstroke motion of actuator 18 causes the pump to drawa vacuum inside suction chamber 22, shown in FIG. 12. A manual release32, shown in FIG. 11, is positioned on actuator 18 to allow a user toquickly release the vacuum from suction chamber 22. First and secondpiston springs 82 provide an axial force to bias actuator 18 at itsupward position. During use, the user presses actuator 18 down againstpiston springs 82, thereby moving a piston 80 on actuator 18 through acorresponding pump piston cylinder 84 defined in handle 12. When theactuator 18 is reversed and moved upward away from the suction head 14,a negative pressure is drawn as the actuator 18 moves the piston 80upwardly through its pump piston cylinder 84 away from suction head 14.A suction valve 44 in the form of a check valve, shown in FIG. 11 andFIG. 12, maintains the negative pressure inside suction chamber 22 heldin place by a seal between rim 28 and a patient's skin. Suction port 48,shown in FIG. 12, communicates the pressure drop associated with themotion of piston 80 from handle 12 to suction chamber 22 on suction head14.

A pump valve 88 is included on handle 12 in some embodiments. Pump valve88 is a check valve in some embodiments that is closed during theupstroke motion of actuator 18, but is opened when pump piston 80 ispressed downward through piston cylinder 84 toward suction head 14. Thepump valve 88 allows the gas in pump piston cylinder 84 to vent out ofthe cylinder as it is pressed downward through piston cylinder 84 towardsuction head 14.

The articulating joint 16 shown in some embodiments, such as the balljoint shown in FIGS. 9-12, provides at least two angular degrees offreedom between handle 12 and suction head 14. The ball and socket jointallows angular movement of handle 12 relative to suction head 14 aboutboth a horizontal axis and a vertical axis.

Thus, although there have been described particular embodiments of thepresent invention of a new and useful device and method for lifting apatient's tissue for insertion of a surgical instrument such as but notlimited to a trocar or Veress needle, it is not intended that suchreferences to particular embodiments be construed as limitations uponthe scope of this invention.

What is claimed is:
 1. A surgical device apparatus, comprising: ahandle; a pump disposed in the handle, the pump configured for drawing anegative pressure; an actuator disposed on the handle, the actuatorlinked to the pump; a suction head attached to the handle at anarticulating joint, the suction head defining a suction chamber in fluidcommunication with the pump, wherein the pump is operable to communicatethe negative pressure to the suction chamber; and a gimbal forming thearticulating joint between the handle and the suction head, wherein thejoint includes at least two angular degrees of freedom between thehandle and the suction head.
 2. The apparatus of claim 1, furthercomprising an actuator travel slot defined in the handle, wherein theactuator travels along the actuator travel slot when the pump isoperated.
 3. The apparatus of claim 2, further comprising a pump springdisposed in the handle.
 4. The apparatus of claim 3, further comprisinga pump piston disposed in the handle.
 5. The apparatus of claim 4,wherein the pump spring biases the piston toward the suction head. 6.The apparatus of claim 5, wherein the interior of the handle forms apump piston cylinder along which the pump piston may travel.
 7. Theapparatus of claim 6, wherein the actuator is linked to the pump pistonand the pump piston moves in a direction away from the suction head whenthe actuator is moved in the same direction away from the suction head.8. The apparatus of claim 7, further comprising a sliding pump pistonseal between the pump piston and the pump piston cylinder in the handle.9. The apparatus of claim 8, wherein the pump piston applies a negativepressure on the suction head when the actuator is moved in the directionaway from the suction head.
 10. The apparatus of claim 9, wherein thejoint includes a second angular degree of freedom between the handle andthe suction head.
 11. The apparatus of claim 1, further comprising asuction valve disposed in the suction head.
 12. The apparatus of claim11, further comprising a gimbal forming the joint between the handle andthe suction head.
 13. The apparatus of claim 12, wherein the handle ispivotable relative to the gimbal about the horizontal reference axis.14. The apparatus of claim 13, wherein the handle is pivotable relativeto the gimbal about the vertical reference axis.
 15. The apparatus ofclaim 14, further comprising a vacuum gauge disposed on the gimbal, thevacuum gauge including indicia representative of a predeterminedpressure.
 16. A surgical device apparatus for lifting a patient tissuefor placement of a surgical instrument for a laparoscopic procedure, theapparatus comprising: a handle forming a cylinder, the handle includingan actuator and a pump, the pump including a piston housed inside thecylinder in the handle, the actuator attached to the piston, wherein theactuator is moveable relative to the handle and wherein movement of theactuator relative to the handle causes the piston to travel in acorresponding motion inside the cylinder; a gimbal pivotally disposed onthe handle, the gimbal including a first angular degree of freedomwherein the handle may be rotated relative to the gimbal about ahorizontal reference axis; a suction head disposed on the gimbal, thesuction head including a suction chamber having a rim positioned forengagement with the patient's skin, the gimbal including a secondangular degree of freedom wherein the gimbal may be rotated relative tothe suction head about a vertical reference axis; and a pressure releasedisposed on the suction head.
 17. The apparatus of claim 16, furthercomprising a travel slot defined in the handle, wherein the actuator ismoveable along the travel slot.
 18. The apparatus of claim 17, furthercomprising a suction valve disposed in the suction head.
 19. Theapparatus of claim 18, wherein the pressure release includes a pressurerelease port passing through the suction head.
 20. The apparatus ofclaim 19, further comprising a vacuum gauge disposed on the gimbal, thevacuum gauge including indicia representative of a predeterminedpressure.